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Assisted living facilities provide help with activities of daily living in a residential setting for individuals who cannot live independently but do not require 24-hour skilled nursing care. In 2002, over 36,000 assisted living facilities served approximately 900,000 residents. The states establish and enforce licensing standards for these institutions. Because states have taken widely differing approaches to regulating and supporting assisted living, they can potentially learn from each other's experiences as they consider changes to their own policies. GAO was asked to review challenges faced by consumers and providers of assisted living and seek out notable state initiatives addressing those challenges in three selected areas: (1) disclosure of full and accurate information to consumers, (2) state assistance to providers to meet licensing requirements, and (3) procedures for addressing residents' complaints. We identified specific examples of individual programs in Florida, Texas, Washington, Georgia, and Massachusetts that highlighted different approaches in these three areas, which other states might wish to consider emulating.

Consumers faced with choosing an assisted living facility often do not have key information they need in order to identify the one most likely to meet their individual needs. Such information includes staffing levels and qualifications, costs and potential cost increases, and the circumstances that could lead to involuntary discharge from the facility. Initiatives in Florida and Texas have made critical data for consumer selection among facilities more readily available. Florida has created a Web site that enables consumers to learn about all of the facilities in their vicinity and identifies those providing the services the consumers are seeking at a specified price range. Texas has mandated a standardized disclosure statement for assisted living facilities, giving consumers concise and consistent data that facilitates comparisons across providers regarding services, charges, and policies. Assisted living facilities are more likely to meet and maintain licensing standards if they can obtain help in interpreting those standards and in determining what concrete changes they need to make to satisfy them. Washington State established a staff of quality consultants to provide such training and advice to assisted living providers on a voluntary basis. Evaluations of the program 6 months after its start and 2 years later documented improvements in provider compliance as well as resident health and safety. However, a statewide budget crisis led to a decision to stop funding the program, in order to maintain traditional licensing enforcement functions. Assisted living residents sometimes need help to pursue any complaints that they may have with their providers, especially when faced with an involuntary discharge. Long-term care ombudsmen are available in all states, but nursing home residents claim most of their attention. Georgia has legislated an extensive array of procedural remedies specifically for assisted living residents that provide them multiple means for seeking redress of their complaints. The existence of these remedies also strengthens the position of residents in the informal negotiations through which most such disputes are resolved in practice. Massachusetts has created a small staff of ombudsmen dedicated exclusively to serving assisted living residents. This allows them to specialize in addressing the particular problems that arise in assisted living facilities.